Provider Demographics
NPI:1225073687
Name:ENT SURGICAL ASSOC PC
Entity Type:Organization
Organization Name:ENT SURGICAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRANDES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-541-0100
Mailing Address - Street 1:27483 DEQUINDRE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5711
Mailing Address - Country:US
Mailing Address - Phone:248-541-0100
Mailing Address - Fax:248-399-3960
Practice Address - Street 1:27483 DEQUINDRE RD STE 201
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5711
Practice Address - Country:US
Practice Address - Phone:248-541-0100
Practice Address - Fax:248-399-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI040F31200OtherBCBS MI
MI040F31200OtherBCBS MI